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Calcific Tendinitis of the RTC M75.30 726.11

Calcific tendinitis of the rotator cuff xray

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms: calcific tendinitis, calcifying tendinitis, hydroxyapatite deposition disease, HADD, calcium rotator cuff

Calcific Tendinitis ICD-10

Calcific Tendinitis ICD-9

  • 726.11 (calcifying tendinitis of the shoulder)

Calcific Tendinitis Etiology / Epidemiology / Natural History

  • Idiopathic calcium deposition (accumulation of basic calcium phosphate crystals (hydroxyapatite) within the rotator cuff.
  • Natural history: strong tendancy for spontaneous resorption with tendon reconstitution.
  • Consists of formative(most painful) and resorptive phases.
  • Women > men, Mean age of onset = 43.5 yers, 22.% bilateral, generally overweight with low levels of alcohol consumptions. (Harvie P, JSES 2007;16:169).
  • Associated with endocrine (hypthyroidism), autoimmune and hormone-related gynecologic disorders (Harvie P, JSES 2007;16:169). Patients with associated disorders have poorer outcomes.

Calcific Tendinitis Anatomy

  • Most commonly affects the supraspinatus, but can affect infraspinatus, subscapularis.
  • See also Shoulder Anatomy.

Calcific Tendinitis Clinical Evaluation

  • Anterosuperior shoulder pain may have radiation to deltoid origin.
  • More painful in formative stage.
  • Physical exam is typically similar to that of Subacromial Impingement 726.10.

Calcific Tendinitis Xray / Diagnositc Tests

  • AP, scapular lateral and axillary views. AP-IR and AP-ER often helpful and demonstrate calcification within the RTC tendons.
  • Consider lab test for hypothyroidism.
  • Ultrasound is sensitive in detecting calcium deposits and helpful for pre and post-op evaluation. (Teefey SA, JBJS 2000;82A:498).

Calcific Tendinitis Classification / Treatment

  • 72.7% of patients treated non-operatively are satisfied with outcome, 85.4% of patients treated with operative excision are satisfied with outcome. Non-operative treatment fails in 46.9% of patients with endocrine disorders and in 22.7% of patients without endocrice disorders (Harvie P, JSES 2007;16:169).
  • Classification: Type A=dense, rounded and sharply delineated calcifications. Type B=multilobular, radiodense, sharply delineated. Type C=more radilolucent and heterogeneous with irregular outlines. Type D=dystrophic calcific lesions of the tendon insertion.
  • Initial treatment = conservative observation, pain can frequently be improved with sub-acromial steriod injection. NSAIDs, ROM exercises.
  • Treatment options: extracorporeal shock waves 70% successful (Daecke W, JSES 2002;11:476), percutaneous needle aspiration and lavage, arthroscopic excision (Porcellini G, JSES 2004;13:503).
  • Arthroscopic Excision Technique: see Shoulder Arthroscopy. After subacromial bursectomy the calcium deposits are located by percutaneous needling based on pre-operative xrays. Calcium deposits are then removed generally with a full-radius resector and curettes. Any residual RTC tears are then repaired in standard fashion, often RTC tears can be repaired by side-to-side suturing. Outcome is dependent on complete removal of calcium deposits. (Porcellini G, JSES 2004;13:503).

Calcific Tendinitis Associated Injuries / Differential Diagnosis

Calcific Tendinitis Complications

  • Residual calcium deposits with continued pain.
  • RTC tear
  • Infections
  • Stiffness
  • Complex Regional Pain Syndrome 337.21
  • Nerve injury: Axillary nerve, Brachial plexus
  • Fluid Extravasation:
  • Chondrolysis: though to be related to heat from electo cautery or radiofrequency probes used during capsular release or capsular shrinkage.
  • Hematoma
  • Chondral Injury / arthritis

Calcific Tendinitis Follow-up Care

  • Post-op: Shoulder immobilizer, Begin elbow/wrist/hand active and passive ROM immediately. Shoulder Pendelum ROM exercises.
  • 7-10 Days: Start physical therapy with PROM, consider AROM depending on any residual RTC tear that needed repairing
  • 6 Weeks: Discontinue sling, progress with AROM.
  • 3 Months: Progress with strengthening.
  • 6 Months: Progressive strengthening, gradual return to normal activities. Home program.
  • 1Yr: Assess outcomes, patient satisfaction.
  • Outomes of Arthroscopic excision: Mean Constant score increased from 55.1 pre-op to 86.4 post-op. Outcomes dependent on amount of residual calcium after excision. (Porcellini G, JSES 2004;13:503).

Calcific Tendinitis Review References